Persistence of Symptoms in Veterans of the First Gulf War: 5-Year Follow-Up
Ozakinci, Gozde, Hallman, William K., Kipen, Howard M., Environmental Health Perspectives
BACKGROUND: During the 1990-1991 Gulf War, approximately 700,000 U.S. troops were deployed to the Persian Gulf theater of operations. Of that number, approximately 100,000 have presented medical complaints through various registry and examination programs.
OBJECTIVES: Widespread symptomatic illness without defining physical features has been reported among veterans of the 1991 Gulf War. We ascertained changes in symptom status between an initial 1995 symptom evaluation and a follow-up in 2000.
METHODS: We assessed mailed symptom survey questionnaires for 390 previously surveyed members of the U.S. Department of Veterans Affairs Gulf War Registry for changes over the 5-year interval in terms of number and severity of symptoms.
RESULTS: For the cohort as a whole, we found no significant changes in symptom number or severity. Those initially more symptomatic in 1995 showed some improvement over time, but remained much more highly symptomatic than those who had lesser initial symptomatology.
CONCLUSIONS: The symptom outbreak following the 1991 Gulf War has not abated over time in registry veterans, suggesting substantial need for better understanding and care for these veterans.
KEY WORDS: Gulf War illness, medically unexplained symptoms. Environ Health Perspect 114:1553-1557 (2006). doi:10.1289/ehp.9251 available via http://dx.doi.org/ [Online 6 July 2006]
During the 1990-1991 Gulf War (GW), approximately 700,000 U.S. troops were deployed to the Persian Gulf theater of operations. Large-scale involvement of U.S. forces in combat in this region largely ended by the winter of 1991. Nevertheless, significant numbers of the 700,000 U.S. service personnel deployed to the region in 1990-1991 presented with medical complaints in the years following operations. Of that number, approximately 100,000 have presented medical complaints through various registry and examination programs (Brown et al. 2002; Stuart et al. 2002). The symptomatology that characterizes their complaints has been described in a number of studies, including investigations from the United Kingdom and other countries (Iowa Persian Gulf Study Group 1997; Lashof and Cassells 1998; Perisan Gulf Veterans Coordinating Board 1995; Unwin et al. 1999). These studies of both randomly sampled and selected populations show that GW veterans clearly report both increased numbers and severity of virtually all symptoms queried when compared with personnel not deployed to the region. Significantly, to date, these symptoms are not reliably associated with characteristic signs or diagnoses of pathological conditions (Eisen et al. 2005; Fukuda et al. 1998; Hodgson and Kipen 1999; Wessely 2004).
Only one study has made an attempt to longitudinally follow GW veterans to determine how their symptomatic presentations have evolved--whether there has been improvement, stability, or decline in the self-reported health of individuals and groups of GW veterans (Hotopf et al. 2003, 2004). This information is critical in trying to understand not just the etiology of such complaints but also how to plan for continued care and rehabilitation.
We have studied, both clinically and by survey, various groups of GW veterans since 1995 (Fiedler et al. 2006; Hallman et al. 2003; Kipen et al. 1999; Peckerman et al. 1999; Pollet et al. 1998). Our original investigations were from a random sample of the Department of Veterans Affairs (VA) GW registry members. We found that physician diagnoses, including those without a generally accepted etiology such as chronic fatigue syndrome, multiple chemical sensitivities, and fibromyalgia, could not account for much of the symptomatology presented and that, based on symptom endorsement and severity, veterans on the registry could be robustly classified as either highly symptomatic (40% of subjects) or mildly symptomatic (60% of subjects) (Hallman et al. 2003). The large number of highly symptomatic "cases" (i. …